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DROP IN CORONARY DEATHS TIED TO TREATMENTS, NOT DIET.

Byline: Lawrence K. Altman The New York Times

Medical and surgical treatments for heart patients have been much more important in the decline in heart-disease deaths in recent years than widespread changes in diet and other means of basic prevention, a new statistical study has found.

About 70 percent of the drop in the number of deaths from coronary artery disease can be attributed to use of clot-dissolving drugs, like streptokinase and tissue plasminogen activator, and procedures like angioplasty and bypass surgery for people with coronary artery disease, according to the study, published today in The Journal of the American Medical Association.

Dietary changes in the general population aimed at preventing coronary artery disease accounted for only about 25 percent of the drop between 1980 and 1990, said the study's lead author, Dr. Maria G.M. Hunink of the Harvard School of Public Health and University of Groningen in the Netherlands.

Hunink said in a telephone interview from Groningen that her team had been ``amazed'' to learn that medical treatment had a larger impact than prevention on the incidence of coronary artery disease, the most common type of heart disease. It remains the leading cause of death of Americans, despite a decline of from 2 percent to 4 percent each year in recent years in this country.

Scientists have been uncertain about the relative contributions of treatment and basic prevention - preventing the development of the disease rather than its recurrence - to the drop in deaths from coronary artery disease. Hunink said that before the study, she would have guessed basic prevention would account for at least half the drop.

``From a public policy perspective,'' Hunink's team wrote, ``these findings suggest that treating patients with diagnosed coronary heart disease may be more cost-effective than primary prevention of coronary heart disease; however, we do not demonstrate this formally.''

Hunink pointed out in the interview that primary prevention measures, like changing the diet and stopping smoking, were still important. The study did not suggest that such prevention was ineffective, merely that treating people who were already ill had a bigger effect.

The reason for her caution is that the costs of various treatments and prevention methods were not part of the study, which relied on a computer simulation model based on national health statistics and clinical trials. Hunink said her team was expanding the study to find the costs and benefits of specific treatment and prevention factors.

Today's study found that, as a basic prevention step, stopping smoking accounted for 3 percent of the decline in deaths and that the improvement in lipoprotein levels accounted for 16 percent. As a preventive step among those who had already developed coronary artery disease, stopping smoking accounted for a 4 percent decline in the number of deaths and the improvement in lipoprotein levels accounted for 18 percent.

Hunink said the effort to combat smoking probably had its greatest impact in preventing heart disease in the 1970s, before the period in her study, thus explaining why the study had found the effect of stopping smoking ``surprisingly low.''

A limitation of the study was that it did not take into account exercise and the use of aspirin and estrogen to prevent heart disease because not enough data were available, Hunink said.

But she added that such factors would account for only a small portion of the decline in deaths.
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Publication:Daily News (Los Angeles, CA)
Date:Feb 19, 1997
Words:561
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